How much does Medicare pay for CPT 86078?

Medicare allowed an average of $48.53 per service and paid $38.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $215.22, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86078?

Blood bank physician services for investigation of transfusion reaction with written report. It was billed 3,021 times to 2,740 Medicare beneficiaries by 126 providers in 2024.

Does 86078 pay differently in an office than a hospital?

Yes. The allowed amount averaged $49.27 in an office setting and $48.52 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 86078 most?

Pathology, with 2,879 services from 119 clinicians. Next are Clinical Laboratory, Pediatric Medicine, Hematology.

CPT 86078

Blood bank physician services for investigation of transfusion reaction with written report

$48.53Medicare-allowed amount per service, averaged across 3,021 services

Providers submitted

$215.22

Asking price, not received

Medicare allowed

$48.53

The fee schedule figure

Medicare paid

$38.35

Balance is patient coinsurance

Providers submitted an average of $215.22 for this code and Medicare allowed $48.53 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $38.35 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $49.27
Hospital / facility: $48.52

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 35 services were billed in an office setting and 2,986 in a facility.

Services: 3,021
Beneficiaries: 2,740
Providers billing it: 126
Total allowed: $146,609

What Medicare pays for CPT 86078

Across 3,021 services billed by 126 providers to 2,740 beneficiaries, Medicare allowed an average of $48.53 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 86078

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	2,879	2,611	$48.45	119
Clinical Laboratory	65	63	$47.89	3
Pediatric Medicine	32	27	$53.58	1
Hematology	19	14	$51.32	1
Medical Oncology	15	14	$50.74	1
Interventional Pain Management	11	11	$50.96	1

86078 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	439	$48.18	$37.00	9
Pennsylvania	298	$47.30	$37.05	10
California	250	$51.23	$36.89	15
New York	236	$53.56	$36.60	10
Virginia	202	$46.04	$37.44	8
Florida	196	$47.51	$37.46	5
Massachusetts	165	$49.61	$37.21	8
Washington	161	$52.89	$37.32	6
North Carolina	135	$45.40	$37.48	6
Illinois	104	$49.31	$37.53	4
Arizona	101	$46.35	$36.85	4
Maryland	97	$49.22	$36.45	6
Ohio	78	$45.77	$37.46	4
Minnesota	71	$47.74	$37.51	4
Michigan	68	$48.21	$37.44	3
Kansas	66	$45.81	$37.47	3
Nebraska	62	$44.68	$36.91	3
Indiana	61	$47.76	$39.57	3
Maine	48	$46.05	$37.58	2
Connecticut	40	$49.47	$36.68	3
Missouri	36	$46.40	$37.49	2
South Carolina	32	$46.02	$37.45	2
Iowa	14	$49.85	$37.58	1
Kentucky	13	$50.01	$37.49	1
Wisconsin	13	$45.21	$37.39	1
New Hampshire	12	$47.28	$34.30	1
New Jersey	12	$51.15	$37.53	1
South Dakota	11	$45.88	$37.36	1

Related codes

86003Measurement of antibody (ige) to allergic substance$5.11
86038Screening test for autoimmune disorder$11.83
86039Measurement of antibody for assessment of autoimmune disorder$10.93
86037Antineutrophil cytoplasmic antibody titer$11.81
86008Measurement of antibody (ige) to allergic substance$17.54
86036Screening test for antineutrophil cytoplasmic antibody$11.80
86015Measurement of actin (smooth muscle) antibody$11.80
86021Antibody identification test for white blood cell antibodies$14.74
86001Measurement of antibody (igg) to allergic substance$6.19
86077Blood bank physician services for cross match and/or evaluation and wr$48.77
86060Measurement for strep antibody (strep throat)$7.15
86041Test for acetylcholine receptor binding antibody$17.97

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.